Aidan:
Hello and welcome to the Ideal Nutrition podcast. My name is Aidan Muir and I’m here with my co-host, Torwin Eerkins. And this is episode 237, where we are going to be talking about nutrition for fibromyalgia. And fibromyalgia is a long-term condition that involves widespread chronic pain.
Diagnosis also requires a severity score above a certain threshold from among six other symptoms. So we’ve got fatigue, trouble thinking or remembering, waking up tired, pain or cramps in the lower abdomen and depression or headaches. And around, it’s hard to get numbers on this, but 2-4 % of the population experiences. So we want to do a bit of a deep dive on this today.
Torwen:
Like you say, it commonly overlaps with gastrointestinal symptoms such as IBS, which has implications for diet choices. And then the fact that it is a pain syndrome means, is there anything that we can do to optimise the diet?
So the role of nutrition is emerging and research does suggest that overall diet quality, fibre intake, micronutrient status, body weight and gut health all do relate to fibromyalgia symptom burden. Which like you say is the pain scores, the fatigue, the sleep and the quality of life and mood.
Aidan:
Obviously both of us have looked into this for long time. We’ve both worked with clients with fibromyalgia and when I was doing research specifically for this podcast.
First place went was Wikipedia. There’s lots of places I go, but for this one, I was like, you know, I’m just gonna get like a real broad, I’m gonna go on Wikipedia. And there was a quote that I found very interesting. It said, reviews in 2023 and 2020 found only limited or no evidence to recommend any specific diet to people with fibromyalgia.
And to be fair, they are saying specific diet. I think it would be silly to completely dismiss diet. Like, for example, as you said just before, a lot of people fibromyalgia have gut symptoms or they will have IBS type symptoms. There’s so much we can do there. Statistically, it’s over 70 % of people with fibromyalgia have IBS-type symptoms.
We go to looking at the weight loss side of things as well. And in many cases, if people had weight to lose, losing weight tended on average to improve symptoms ranging from pain through to a bunch of other stuff. So, we know that diet plays a role there.
We know that oxidative stress and inflammation plays a role in this case that I can do there. That area is always going to be a bit more debatable, but we know that diet can play a role there. And there’s heaps more that we’re going to talk through as well.
Torwen:
Just wanted to add one thing that in all of this that we’re to talk about today. We do often have to consider that in this population of patients capacity for eating well and cooking and having time because of this pain and fatigue is often reduced. So we’re to be talking about lots of strategies. But we’ll also mention what we think is worth doing.
Aidan:
Yeah, super valid, particularly. Yeah, all the variables going into this. But yeah, so what we’re going to do, we’re going to start with specific nutrients, which is like the complete other end of the spectrum. So I’ve added a review in the show notes, which covers a broad range of research on this.
But a direct quote from that, “clinical trials with vitamin D, magnesium, iron and probiotic supplementation show promising results.” That’s a pretty consistent finding. Logically, antioxidants like vitamin C and vitamin E can help. I wouldn’t necessarily say that research is at that stage where I would make strong claims around that.
Around 40% of people with fibromyalgia have low vitamin D. But that’s the same kind of problem we see in a lot of other areas where it’s chicken or the egg. Do they have low vitamin D and that’s contributed to fibromyalgia symptoms? Or do they just not get a lot of sunlight on average because people in general often have low vitamin D?
Or do they get less because of fibromyalgia and the symptoms that are associated with that? One way I always very simply bypass that problem is just looking straight at does supplementing vitamin D help the symptoms on average? And so far the research has shown that yes, that does help. It’s not magical, but it does help.
Torwen:
One study particularly looked at around 50,000 units of D3 per week. To put that into perspective, a lot of people might supplement with a thousand units a day. So 7,000 units a week. So this is a big amount. But after eight weeks, they did show significant improvement in those fibromyalgia scores. And that’s pretty promising.
Aidan:
Yeah, absolutely. So two other areas, probiotics and magnesium. So talking about probiotics. We know that people with fibromyalgia often have altered microbiota. With some of this being associated with symptoms. That’s also the same chicken or the egg scenario, but direct quote from other researchers as well. Another broader review.
They found a study where they said a pilot study to investigate the effect of seven weeks of supplementation with probiotics showed improved cognition, particularly around impulsive choices and decision making. And that was in 40 subjects. So it’s like there’s promise in that space as well. And magnesium is one that has heaps of theoretical reasons it can be beneficial. But, at this stage, practical research is just weakly supporting that. I wouldn’t make strong claims on that yet as well.
Torwen:
Are there any other sort of specific nutrients it makes sense to do blood tests and see if there are any deficiencies and supplement as we normally would? Should we move on to specific diets? Or was there anything else you wanted to add?
Aidan:
We could do supplements or diets.
Torwen:
Let’s chat about supplements.
Aidan:
Okay, let’s do let’s do supplements. It’s just a huge list. And this is something that I like the entire time of looking into. The list is so long that it’s really hard to figure out what to prioritise. And I think a very common sense take is that different people are going to require different things.
Because it is such a broad condition. I know it’s like very cliche to be like people are individual, but like I am being serious with this one. Listing a bunch of ones that do have research. There’s Coenzyme-Q10. That seems pretty broadly across this that seems to help a lot of people.
Most studies if anyone’s interested use about like 300 milligrams per day of that for like around three months and it’s consistently been shown to help the mechanisms of improving mitochondrial activity and decreasing inflammation. Listing other stuff because it’d be a lot to go through all of them ginkgo biloba, L-carnitine, creatine, melatonin and then there’s a much, much longer list. I did find a list ages back that I wish I like documented where I found this.
It was a list that had like 10 to 20 supplements that just had good evidence for helping at least seven out of 10 people with fibromyalgia. And it kind of acknowledges this like individual variation, but it’s like, these are the ones that have been shown research to help the most often.
Torwen:
And again, do you want to take a list of 20 supplements? Probably not. But that’s why it’s so important, like Aidan mentioned, that it’s individualised and whatever works for you is what you should be doing.
Aidan:
In our notes, I made a note for myself that was like, I’d personally only use the stuff that has no downside and ideally fits the budget. Like if I’m using creatine as an example, no downside in many cases, unless you happen to get GI distress from that.
And then the fitting of the budget. Like if you have 20 supplements, it gets out of hand really quickly. If you have 20 supplements, suddenly the risk of downside gets higher because they can like interact with each other. You can unintentionally double up on certain stuff. And then the practicalities of taking 20 get hard as well.
Like a lot of people don’t see that as an inconvenience until you do it. And then you become inconsistent with taking stuff because you don’t want to take 20 plus different kinds of pills and stuff.
Torwen:
For sure. Let’s move on to specific diets then. So, because like we mentioned, fibromyalgia patients have a lot of GI symptoms that might overlap with things like IBS. So nausea, abdominal pain, again, that tiredness, fatigue leading to different food choices. There are many diets that have been studied in this space with, again, differing outcomes.
Some positive and some kind of neutral, but maybe anecdotally more positive. So low FODMAP, if we start with that one. Around 70 % of fibromyalgia patients suffer from IBS.
And a lot of people do hypothesise then that going low FODMAP will help because it does reduce those fermentable carbs that trigger gut symptoms and sensitivity. A specific four-week intervention trial of 38 women with fibromyalgia showed a significant reduction in their gastrointestinal symptoms when they went low FODMAP as well as a reduction in their pain scores, which is positive.
As with anyone who is going low FODMAP though, it does make sense to do it in a way where you go through the elimination period, you do the trial and you reintroduce as tolerated. So you don’t have that unnecessarily restricted diet.
Aidan:
Yeah, and it makes sense because even, even if it didn’t look as positive, I would always view potential for the low FODMAP diet because that fermentation process. And even when we look at research on inflammatory bowel disease where it’s not as promising as IBS and stuff like that. You still see things like a reduction in bloating because you have less of these fermentable carbs. So it makes sense. And yeah, just doing it.
I’m always cautious when we speak about FODMAPs. I don’t want to hype it up too much. And then people just do that forever. It’s like, obviously do the reintroductions and stuff. Another line I also do say is I’ve never seen anyone do the low FODMAP diet well without seeing a dietitian. Obviously, anybody who listens to this knows I’m not constantly like plugging seeing dietitians. I obviously rate us, but I’m not constantly plugging it.
And it’s one area where it’s like, I’ve seen people lose weight well without dietitians. I’ve seen people do heaps of great things without working with a dietitian. The low-fibre-up diet to this day, I’ve still never seen anyone do it well by themselves. Continuing on. So, gluten-free, have you seen research on gluten-free stuff?
Torwen:
I mean, it kind of fits into a similar category. If we’re looking at non-celiac gluten sensitivity, which could be that fructan component in wheat, if we reduce that as well, it’s likely that some form of gastric symptoms is reduced.
Aidan:
Yeah.
And then other areas as well, like there were a few that just like found general improvements in fibro symptoms. And there are a few that found no benefits. I lean towards this not being something I recommend. Like it would be something I’d be more open-minded to if a lot of research was obviously very positive. But the fact that it’s like pretty mixed and then how we theoretically think about gluten. I just don’t think it really matters for this.
Another area that is in the research as kind of a category is low-calorie diets. And so far, it has been found to improve a lot of symptoms ranging from pain through to mental health stuff. Obviously, only do it if relevant. And even then, the research is on very low-calorie diets in many cases.
I don’t think it’s about the very low-calorie diet. I do think it’s about just being in a calorie deficit. Personally, I would do it in a different way. I’d probably be a bit slow with it, not necessarily slow. I just wouldn’t go very low-calorie.
Torwen:
Yeah, exactly that. Reducing body weight can help with the symptoms. Can it be done through a more moderate caloric restriction is probably my thought as well.
Other things then are vegetarian diets. So a very plant heavy diet, which will naturally increase things like fibre, antioxidants. I found that this is more anecdotally that people are reporting improvements. What are your thoughts?
Aidan:
I did see a study, probably like 10 years ago on this. And I found that very interesting because I obviously know a lot of people with fibromyalgia. And I was like, oh, it’s interesting that something is showing that some form of dietary pattern seems to help. I think it’s probably from what I’ve seen just due to a better dietary quality. I think it’s more antioxidants, micronutrients, fibre, potentially lower calories. Like, I think it’s less about the vegetarian and more about that side of things.
Torwen:
The exact same with the Mediterranean diet then I think, which emphasises anti-inflammatory foods, fatty fish, fibre, healthy fats. But essentially, when you do a diet like that, you’re just improving overall quality and probably having a lot more whole foods than you might be if you’re not basing it off of a diet like that.
Aidan:
Absolutely.
And then we’ve also got the mental health side of things as well, where it’s like we’ve seen research finding benefits from the Mediterranean diet. Bit of a tangent here, but I’ve seen people like ripping on like the SMILES trial and a few other ones. Pointing more to the fact that it’s this involved goal setting and this involved other stuff that improves depression. But I’m like, it does seem to be both.
Like it does seem to be nutrition, it does seem to be other stuff. But a lot of research on depression is used in the Mediterranean diet. That doesn’t mean there’s other dietary approaches that don’t help as well, just through improving dietary quality. It’s just like, that’s just the first area that seems to have been studied and has found benefits. But we do have that as another area as well.
Torwen:
Practical recommendations in this space then, or again, anything else there that you wanted to add? Yeah, I think if we, like we say, if we start with supplements and nutrients and things like that, it makes sense to get regular blood tests to address any nutrient deficiencies. That’s probably the first place. And a practical recommendation I’d start with.
Implementing food changes then, like we said at the very start, can be more difficult in this population. So doing it in a simple, sustainable, easy way. Again, maybe seeing a dietitian that can help with strategies like batch prepping, pre-prepped options, frozen vegetables, salad mixes, things like that can help.
Aidan:
Yeah, I think where I stand is that diet absolutely can play a role. It’s debated for a reason how much of a role it can play, but it definitely can play a role. I still think it’s just one piece of the puzzle. And it’s a very complicated puzzle. But it can help in many cases. And I think when you look at it through that capacity perspective, it is like about just like doing what you can with the circumstances as well.
Torwen:
I think so too. We’ll wrap up there then. So this has been a little summary of nutrition strategies for fibromyalgia. As always, if you’ve enjoyed this episode, please leave us a positive review. It means a lot to us, and we’ll catch you in the next episode. Thanks.